Prenatal Health Care Data Dashboard

The Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS) collects information from people about their attitudes and experiences before, during, and after pregnancy.

The end of the PRAMS survey asks, "We would love to hear more about your story! Is there anything else you would like to share with us about your experiences around the time of your pregnancy?"

Many mothers share their thoughts and stories. These comments provide valuable insights into many maternal health topics, including prenatal health care.

Many mothers shared positive experiences they had with their prenatal care.

“I felt the care I received during and after both pregnancies was terrific. All my questions were answered, and I felt I had full support, and everyone truly cared about the health of me and my babies. I never felt pressured to do something I wasn't comfortable with. I was always given info so I could make my own informed decision.”

“My doctors provided a lot of support and info during my pregnancy and delivery. I feel I have the tools necessary to care for myself and child in the best way possible.”

“I am definitely aware of the experiences that black women have with childbirth - but my experience was not like that. I had good care & attention I even had preventative services that was able to prevent my pregnancy from being extended. I appreciate the extra attention I was shown given the statistics for black mothers - everything was explained to me, my risk and my options.”

However, not everyone had a positive experience with their prenatal care.

“My experience with my doctor during my pregnancy made me feel like I wasn't important, she didn't explain the risks of continuing my pregnancy beyond the due date, she went on vacation the week of my due date, I was left confused and worried.”

“During the beginning of my pregnancy there were a few occasions where lab technicians lacked the care and attention that I needed. They did not make me feel safe and bruised me. On one occasion I had a panic attack and ended up switching care due to the lack of technicians at the facility.”

Several mothers shared about discrimination they experienced during their prenatal care.

“I had a bad experience with my OBGYN! She hadn't taken the time to let me know I had anemia until they very end of my pregnancy to the point that I needed to iron fusions and she had ignored how tired I was and when I wasn't able to make it an appointment. She had me do a drug test even though I don't drink or do any drugs. I felt that she was discriminating because of my age and race.”

“The doctor had a personal bias towards me—I think it was because I was African American, I think she was trying to imitate what a black girl was supposed to talk like. It was very inappropriate. That's why I asked to switch to a different OB.”

“Because of being previously discriminated against and my babies having injuries from delivery I was too afraid to start prenatal care and only went because I couldn't afford a doula or midwife assistance to have my baby at home.”

Though many mothers expressed how helpful the education they received was, some wished they received more education during their prenatal care.

“I felt as though my OBGYN was a little haphazard when it came to my weekly check ups towards the end of the pregnancy. It was my first pregnancy, and she knew that, yet she neglected to tell me what to expect when it came to labor pains or how to properly identify labor. Almost all of my knowledge of labor came from the internet, which is obviously not most reliable. The OB should lay it all out there, especially for first time mothers because I honestly didn't even know what questions to ask since it was all so new to me.”

Some mothers felt that they did not have enough time with their providers during prenatal care visits.

“While I was pregnant, I felt rushed through visits with the same phrase over and over "it's normal", but not really solutions or a second thought.”

“Doctors are always so busy, and it feels like they don't have time for you and it's hard to get an appointment.”

Some mothers discussed barriers they faced to accessing prenatal care.

“I wasn't able to receive nay prenatal care while pregnant until the 20th week of my pregnancy because I could not find a doctor who would accept my Medicaid who as available. I would make an appointment and like 2 days before the appointment, the receptionist would call me and say they do not accept my insurance. I couldn't get any appointments. And all the Medicaid doctors were booked until next year. I had to drive really far to the appointment.”

“I failed to have prenatal care honestly, I was scared. I was scared I'd be hurt again during my procedure.”

“…It was extremely difficult to get to any prenatal appt due to covid and having two children that had to come with me, but they weren't allowed to come in. They told me to leave them in the car.”

Several mothers noted the importance of public insurance for receiving care.

“I do want to make note that for myself, and for many women in my family, BadgerCare, state insurance, and/or Medicaid was essential in being able to afford pre and postnatal care as well as afford the cost of labor and delivery, and all the wellness checks for baby after they were born. I'm grateful we were able to qualify even though our income was slightly over the 'poverty' level, and I hope all women in Wisconsin continue to get proper healthcare with Medicaid when needed during pregnancy."

The Wisconsin Maternal Mortality Review Team (MMRT) reviews all deaths that occur during or within one year of the end of pregnancy. The team is composed of experts who represent organizations involved in the care of pregnant and postpartum people in Wisconsin. The MMRT makes recommendations for each pregnancy-related, preventable death. These recommendations are intended to prevent future similar deaths. MMRT recommendations address several topics, including prenatal care.

Many recommendations stressed the importance of care coordination during pregnancy.

• Health care organizations should provide professional support and wraparound services for any person with cognitive or developmental delay at each interaction with health care system.
• Facilities should have care coordination for high-risk patients that includes scheduling appointments, ensuring transportation and follow up if a patient does not present to an appointment.
• Hospitals should assign community health workers to all individuals who have difficulty navigating healthcare system (due to immigration status, disability, language barrier, financial constraints, or similar).
• Health systems, governmental agencies, and private funders should fund the expansion of systems like ConnectRX in Dane County to the entire state to provide care coordination, doulas for Black women, etc.

Several recommendations addressed screening opportunities during prenatal care visits.

• Prenatal care providers should screen all patients for depression at prenatal and postpartum visits and educate patients about symptoms for postpartum depression and how/when to seek care.
• Providers should complete screening, including verbally, for substance use disorder for all prenatal patients, and patients should be provided assistance and support in treatment of addiction.
• Health care staff should ask partners to leave the room for intimate partner violence screenings as a routine practice.

Several recommendations addressed the need for culturally competent prenatal care.

• Medical and nursing schools and pipeline programs should work to increase diversity in healthcare workforce as an important factor for eliminating inequities in healthcare.
• Payers should incentivize health systems to provide in-person culturally competent care coordinators from diverse backgrounds as part of the care team for complex patients to make sure all healthcare needs are addressed.

Many recommendations detailed how prenatal care can be used as a tool to support pregnant people with substance use disorder.

• The state should provide funding and support to healthcare systems to assure safe supportive services for pregnant or postpartum people who have a history of trauma or substance use disorder.
• Providers should implement group prenatal care to increase social connectivity for women with substance use disorders.
• Any health care provider working with patients with history of substance use should offer harm reduction strategies at every office visit.

Data definitions

The Kotelchuck index

The Kotelchuck index classifies prenatal care adequacy based on both when prenatal care began and if the number of prenatal care visits aligns with recommendations from the American College of Obstetricians and Gynecologists. The index measures quantity and not quality of prenatal care. A person’s prenatal care is classified as one of the five index categories:

• Adequate plus prenatal care: Prenatal care began by the end of the 4th month of pregnancy and 100% or more recommended visits received
• Adequate prenatal care: Prenatal care began by the end of the 4th month of pregnancy and 80–109% recommended visits received
• Intermediate prenatal care: Prenatal care began by the end of the 4th month of pregnancy and 50–79% recommended visits received
• Inadequate prenatal care: Prenatal care began after the 4th month of pregnancy or less than 50% recommended visits received
• No prenatal care

Prenatal care

Prenatal care refers to health care during pregnancy.

Regions and urban vs rural counties

The maps in the dashboard show data based on where an individual lived at the time of their delivery. Urban versus rural counties are defined by the Wisconsin Office of Rural Health. Regions are defined by the Division of Public Health to align with the division’s regional offices.

Insurance

Insurance is defined in two different ways within the dashboard, depending on the data source. Vital records data defines insurance as coverage during delivery, as reported on the birth certificate. Insurance during pregnancy is reported by PRAMS survey participants. Private insurance includes any private insurance paid for by the individual, someone else, through a job. This includes TRICARE or other military health care. If an individual says they are covered by both private insurance and public insurance [Medicaid, BadgerCare Plus (ForwardHealth), Indian Health Service, or other tribal health care], then they are included within the private insurance group.

Race and ethnicity

The race and ethnicity groupings used in the dashboard are not mutually exclusive, meaning that a person may be included in multiple groups. American Indian or Alaska Native includes everyone who identified as American Indian or Alaska Native, including those who also identified as Hispanic or another race. Hispanic includes everyone who identified as Hispanic.

Household income

Household income group is based on three factors: 1) an individual and their spouse or partner’s total income before taxes during the 12 months before their new baby was born, 2) the total number of individuals who depended on the income, and 3) Federal Poverty Level guidelines during the birth year, as released by the U.S. Department of Health and Human Services. Individuals in the group “< 100% federal poverty level” had a household income below the federal poverty level, as adjusted for the number of household members. Individuals in the group “100–199% federal poverty level” had a household income at or just above the federal poverty level. Individuals in the group “200%+ federal poverty level” had a household income that was over two times the federal poverty level.

Other data concepts

Percentages

The data in this dashboard are shown as percentages. A percentage represents a fraction of a whole where the whole equals 100. As an example, this dashboard tells us that 79.9% of Wisconsin mothers had adequate prenatal care in 2024. The population of all Wisconsin mothers or people who gave birth represents the whole. If the population of all Wisconsin mothers was 100 people, then 79.9 people would have had adequate prenatal care.

While it is commonly understood that percentages add up to 100, the percentages shown within some graphs in this dashboard do not add up to 100. This is because the those graphs are only showing one of two possible scenarios: the percentage of mothers who had adequate prenatal care, for example. If the percentage of mothers who did not have adequate prenatal care was also shown, then those two numbers would add up to 100 as there are only two possible scenarios: having adequate care or not having adequate care.

Confidence intervals

Hovering over a data point within the dashboard gives a pop-up box with an interpretation of that data point. The pop-up box also gives two numbers that represent the 95% confidence interval. While a data point is the best estimate of the truth based on the information available, we cannot know with certainty that it is the true value for the entire population. A confidence interval is a range of numbers that likely contain the true value. The range of a confidence interval is impacted by the number of people included in the data, how much each person’s data differs from others, and the level of certainty that the range contains the true value (in this case, 95% certain).

Health care access, use, and experiences may differ across populations due to differences in several factors, including social and environmental factors. The University of Wisconsin Population Health Institute’s Model of Health shows how community conditions impact health. It important to remember that blame for adverse health outcomes, including health care experiences, should not be placed on the individuals or populations who experience them.

Age and education level are important factors impacting access to health care. Individuals who are younger or with fewer years of education may have limited connections with health systems and services or may experience additional barriers to care.

A person’s insurance coverage can impact their access to health care and their experiences while receiving care, ultimately impacting health outcomes. Insurance coverage and type can determine when, where, and with whom a person is able to receive care, greatest impacting communities with health care service shortages or other barriers to quality care. Additionally, medical procedures not covered fully by health insurance can prevent people from getting the medical attention they need. Confusion around insurance policies may contribute to delayed care and interrupted care coordination.

While race or ethnicity does not have any impact on the biology of a person, it can shed light on how different populations experience health care as well as social and economic conditions. Some populations may experience systemic barriers to quality care, safe housing, economic opportunities, and more—both historically and currently—that impact care access and health outcomes. It is also important to understand why people may distrust health care systems and to foster feelings of trust and safety within health care settings. When we see differences between racial and ethnic groups we can better understand where to place resources to improve the conditions populations are living in and increase access to health care inside and outside the hospital.

Data sources, including the ones used to create this data dashboard, may be limited in their ability to show data for all populations or for smaller geographies. Additional maternal health data may be also available that is not shown on the data dashboard.

If you have any questions around maternal health data or would like to request data, email DHSFHSData@dhs.wisconsin.gov.

Additional data and information related to maternal, infant, child, and adolescent health can be found on the Family Health Data webpage. This webpage contains resources that are freely available from state and national data sources. You will also find a guide for using WISH (Wisconsin Interactive Statistics on Health) to show you how to do your own data queries on a wide-range of health indicators in our state and communities.